The Effect of Renal Scarring on Spontaneous Resolution and Breakthrough Infection in Children with Vesicoureteral Reflux

ABSTRACT

PURPOSE: Primary treatment of children with vesicoureteral reflux (VUR) is antibiotic prophylaxis until the reflux resolves. But, it is not easy to determine in which patients the reflux resolves. We sought to determine whether renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. MATERIALS AND METHODS: A total of 90 children, 54 boys and 36 girls, mean age 15.1 (range 1-98) months, with VUR were analyzed retrospectively. Eighty-six presented with febrile urinary tract infection (UTI) and 4 with prenatal hydronephrosis. Technetium Tc 99m dimercaptosuccinic acid (DMSA) scans were performed at 4 months after resolution of a febrile UTI. All children were initially treated with antibiotic prophylaxis (Bactrim(R); TMX-SMX 2 mg/kg/day) and 40 underwent antireflux surgery. Median follow-up was 26.1 (range 6-52) months. Reflux grade was defined by use of the International Classification System. We analyzed the incidence of renal scarring according to reflux grade, reflux resolution, and reason for antireflux surgery. RESULTS: Normal DMSA scans were documented in 63 (70%) children and renal scarring in 27 (30%). Children with renal scarring presented high grade (III-V) VUR. VUR with renal scarring was not resolved spontaneously and increased the risk for breakthrough UTI. Renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. VUR grade, however, did not help to predict the prognosis of reflux. CONCLUSIONS: We conclude that VUR with renal scarring has a low spontaneous resolution rate and a high risk for breakthrough UTI. This information would be helpful when counseling the families of patients with VUR.